Journal of Psychology and Clinical Psychiatry

Clinical Paper Open Access Psychotherapy of phantom pain in oncology

Abstract Volume 9 Issue 6 - 2018 Psychotherapy using the “mirror box” (by V. Ramachandran) and progressive muscle Tkachenko G, Stepanova A relaxation (by E. Jacobson) in combination with music are effective in correcting N.N. Blokhin NMRC of Oncology of the Ministry of Health of phantom pain in patients with malignant tumors of bones and soft tissues. Analysis of Russia, Russia VAS data before and after the correction showed a significant reduction in phantom pain in the patients examined: from 73.9+9.0 to 58.9±7.9 scores, respectively Correspondence: Tkachenko G, N.N. Blokhin, NMRC of (Student’s t-test = 4.7; P <0.05). By Wong-Baker scale, a significant decrease in the Oncology of the Ministry of Health of Russia, Moscow, Russia, intensity of phantom pain from 7.7±1.1 to 5.7±1.1 scores (Student’s t-test =5, P <0.05). Email

Keywords: psychotherapy, phantom pain, VAS, Wong-Baker scale, method of Received: April 20, 2018 | Published: November 20, 2018 “mirror therapy”, progressive muscular relaxation

Introduction years. Clinical and psychological research provided for the use of questionnaires to assess the intensity of pain: visual analogue scale Amputation or removal of any part is usually associated with a (VAS) and Wong-Baker faces pain scale. Statistical processing of feeling that the missing part is still present and causes disorders of the results was carried out using a package of statistical programs. different types of sensitivity, but mainly excruciating pain sensations. The comparative analysis was carried out using Student’s t-test. The The phantom pain is a false sensation, an illusion of the presence significance of differences in indices was P <0.05. We have chosen of the missing part of the body. The symptoms of phantom pain the methods that proved to be the simplest but at the same time, are especially pronounced and often manifest themselves after effective for reducing phantom pains: “mirror box” technique and surgery for malignant tumors. According to different authors, the PP progressive muscle relaxation. 10 sessions of “mirror therapy” (by V. manifestations in cancer patients are observed with a high frequency Ramachandran) and 10 sessions of progressive muscular relaxation 1 from 30 to 90%. Phantom pains can appear immediately after (by E. Jacobson) have been conducted with each patient, individually, surgery but their onset can be observed after a considerable time after in combination with music or sounds of nature. The sessions were amputation. With time, the pain becomes less pronounced, and its held 2 times a day for 30 minutes of “mirror therapy” and 45 minutes incidence decreases. However, there are cases when phantom pain of relaxation. The number of sessions was determined by the terms of persists even 5-7 years after amputation. As clinical experience shows, the patient’s hospitalization after the surgery (10-14 days). even with the complex application of modern anti-neuropathic agents, opioid and non-opioid analgesics, regional blocks, the treatment of The proposed method included four steps: 2,3 phantom pain in many cases does not give positive results. That is 1. Stage I – before surgery – psychological preparation of the why it is important to search for effective methods of prophylaxis and patient for amputation (exarticulation and other surgical correction of phantom pain in cancer patients. Along with medical interventions). At this stage, information and explanatory work treatment, in many countries the great attention has been recently was carried out with the patients, the content of which was paid to the psychotherapy. It has been proven that one of the valuable determined by the specifics of the diseases: the patient received tools that can be used to reduce the intensity of pain is psychological information from the doctor about the forthcoming surgical interventions and various methods of psychotherapy, which, on the intervention and its consequences (including the possible 1,4 one hand, are safe, but, on the other hand, are very effective. In the development of phantom pain). international practice, hypnotherapy, biological feedback, “mirror box” technique, autogenic training, neuroinduction and self-induced 2. Stage II – after surgery – psychological diagnosis: Before the hypnosis, and many other methods are widely used.1,5 In this regard, psychotherapy, a psychodiagnosis was carried out, including an the studies in this area are relevant as well as the use not only of assessment of the pain syndrome, as well as the actual mental existing techniques, but the creation of new effective methods of state for detecting depression, high level of anxiety caused by psychological correction of phantom pain. oncological disease and greatly complicating the correction of phantom pain. Carrying out psychodiagnosis is important for Purpose increasing the patient’s motivation for psychotherapy. Evaluation of the effectiveness of psychotherapy methods in 3. Stage III – psychotherapy – conducting psychotherapeutic correcting phantom pain in patients with malignant tumors of bones methods aimed at reducing the pain. and soft tissues. 4. Stage IV – (before discharge) – repeated psychodiagnosis to Material and methods evaluate the effectiveness of the therapy. 14 patients with malignant tumors of bones and soft tissues Results and discussion were included in the study: bone osteosarcoma (35.7%), soft tissue sarcoma (64.3%), who underwent amputations and exarticulation Quantitative analysis of VAS data before and after the correction of extremities in combination with lymphadenectomy aged 36 to 60 showed a significant reduction in phantom pain in the patients

Submit Manuscript | http://medcraveonline.com J Psychol Clin Psychiatry. 2018;9(6):631‒632. 631 © 2018 Tkachenko et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Copyright: Psychotherapy of phantom pain in oncology ©2018 Tkachenko et al. 632 examined: from 73.9+9.0 to 58.9±7.9 scores, respectively (Student’s Conflict of interest t-test = 4.7; P <0.05). There was a clear improvement in the overall well-being of the patients after the course of correction. A qualitative The author declares that there is no conflict of interest. analysis of the test results showed that phantom pains of varying intensity were initially observed in all patients: only 1 patient (7.1%) References showed moderate pain; 1 patient noted unbearable pain (7.1%); severe 1. Cárdenas K, Aranda M. Psychotherapies for the Treatment of Phantom pain was noted in all others (85.8%). After the course of psychological Limb Pain. Rev Colomb Psiquiatr. 2017;46(3):178−186. correction, the number of patients with moderate to severe pain 2. Reuben S. Persistent postoperative pain: pharmacological treatment significantly increased to 78.6% and the number of patients with a strategies in the postoperative setting, Pain 2008 – an Updated pronounced level of phantom pains decreased (21.4%). By Wong- Review. Castro-Lopes J, Raja S, Scmelz M, editors. IASP Press: Baker scale, a significant decrease in the intensity of phantom pain Seattle;2008;159−169. from 7.7±1.1 to 5.7±1.1 scores (Student’s t-test = 5, P <0.05). The 3. Sindrup SH. Clinical pharmacology of antiepileptics and antidepressants intensity of pain of 8 scores was revealed in 2 patients (14.3%), of in the management of neuropathic pain. Pain 2008- an Updated 4 scores – in 1 patient (7.1%), of 6 scores – in 11 patients (78.6%). Review. Castro-Lopes J, Raja S, Schmelz M, editors. JASP Press. Along with a decrease in phantom pain, all patients demonstrated Seattle;2008:217−223. improvement in sleep, mood, and increased physical activity. 4. Castelnuovo G, Giusti EM, Manzoni GM., et al. Psychological Treatments Conclusion and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in The study showed that the proposed methods of psychotherapy Neurorehabilitation. Front Psychol. 2016; 19;7:115. using the “mirror box” and progressive muscle relaxation in 5. Diers M, Flor H. Phantom limb pain. Psychological treatment strategies. combination with music are effective in correcting phantom pain in Schmerz. 2013;27(2):205−213. patients with malignant tumors of bones and soft tissues. Acknowledgements None.

Citation: Tkachenko G, Stepanova A. Psychotherapy of phantom pain in oncology. J Psychol Clin Psychiatry. 2018;9(6):631‒632. DOI: 10.15406/jpcpy.2018.09.00599